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  • Title: Oral contraceptives and focal nodular hyperplasia of the liver.
    Author: Hagay ZJ, Leiberman RJ, Katz M, Witznitzer A.
    Journal: Arch Gynecol Obstet; 1988; 243(4):231-4. PubMed ID: 3223780.
    Abstract:
    A variety of benign liver tumors associated with the use of oral contraceptives has been described. However, there is controversy regarding the possible relation of focal nodular hyperplasia of the liver to oral contraceptive therapy. Over a ten-year period at the Soroka Medical Center, two young women were found to have hepatic tumors diagnosed as focal nodular hyperplasia. In both cases the hepatic nodules were an incidental finding at laparotomy and were thought to be metastatic tumors. The clinical and pathological findings in both cases are reported. The features of focal nodular hyperplasia and its possible relation to oral contraceptive use is discussed. The controversy concerning the possible relation of focal nodular hyperplasia (FNH) of the liver to oral contraceptives (OCs) continues. Sex steroids, such as estrogen, affect the liver more than any other organ outside of the genital organs. Research shows that in 10-40% of women taking OCs the bile secreting function of hepatocytes is impaired. Even though most liver cell adenomas in young women have been associated with OC use, this has not necessarily been the case for FNH. In addition, many studies demonstrate that FNH does not progress to become hepatic carcinoma, and FNH has never been fatal. Despite the fact that FNH mainly occurs in women, it has been present in newborn infants and in the elderly. Moreover, there is no evidence that using OCs increases the frequency of FNH. 2 cases of FNH at a medical center in Beer-Sheva, Israel only add to this controversy. A 21 year old, unmarried woman had been taking OCs 4 years prior to her arrival at the hospital. Complaining of 2 weeks of pain in the left chest and in the left upper quadrant of the abdomen and upon completion of a physical exam, surgery was performed and revealed a primary Ewing's sarcoma of the bone marrow of her lower left ribs. The liver appeared normal except for a 3x2x2 cm FNH on the anterior surface of the left lobe. She died 1 month later from respiratory arrest. A 32 year old woman who did not use OCs indicated pain for 6 hours in the left lower quadrant of the abdomen. Practitioners found the left Fallopian tube and ovary gangrenous and twisted. In addition, they found multiple FNHs on the liver. A total hysterectomy, bilateral salpingo-ovariectomy, and a liver biopsy were performed. She recovered with no complications.
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